Provider Demographics
NPI:1801106455
Name:COLEMAN, DIANNA CARMELL (MA)
Entity type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:CARMELL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 CASTOR AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-305-6682
Mailing Address - Fax:267-350-4887
Practice Address - Street 1:8220 CASTOR AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-305-6682
Practice Address - Fax:267-350-4887
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical